Frenectomy

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Frenectomy
Lingual Frenectomy - Before and After.jpg
Lingual frenectomy performed on a 5-year-old boy using a LightScalpel 10,600 nm CO2 laser. The photos show the frenum under the tongue immediately before the procedure and the surgical site immediately after.
Other namesfrenulectomy or frenotomy)

A frenectomy is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far. It can refer to frenula in several places on the human body. It is related to frenuloplasty, a surgical alteration in a frenulum. Done mostly for orthodontic purposes, a frenectomy is either performed inside the middle of the upper lip, which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy is a very common dental procedure that is performed on infants, children, and adults. A similar procedure frenulotomy is where a tight frenulum may be relieved by making an incision in the tight tissue.

Contents

Types

There are several frenula that are associated with types of frenectomy:[ citation needed ]

Pediatric and infant frenectomies

In the past, the frenectomy procedure was perhaps the most popular of soft tissue operations in younger patients. Many labial and lingual frenum (tongue- and lip-ties) were snipped by a midwife, family doctor or dental surgeon. [1] The overall awareness and treatment of tongue- and lip-ties especially in breastfeeding infants has increased over recent years. [2] Frenectomies are routinely performed on infants to improve breastfeeding outcomes. [3]

In 2020, medical professionals raised the concern that a recent rise in unnecessary frenectomies on infants may be encouraged in part by information shared in online parenting groups. While public healthcare options (e.g. NHS) may not cover frenulectomies, in part due to these concerns, private clinic surgeries remain viable options for concerned parents. [4]

Traditionally tongue-ties are diagnosed by appearance alone; newer research advocates for a functional assessment to determine any deleterious effect on breastfeeding. Before any surgical intervention for difficulties related to breastfeeding, preoperative consultation with a certified lactation consultant is recommended. [5]

Laser frenectomy with CO2 surgical lasers

Frenectomies can be safely and efficiently released with the soft tissue 10,600 nm CO2 laser with predictable and repeatable tissue response, fast ablation and instant hemostasis. [6] The extremely precise cutting, minimal collateral damage, clear and bloodless operating field, make the CO2 laser a good choice for frenectomy procedures. [7] [8] CO2 laser oral surgery also features less wound contraction and reduced scarring or fibrosis in comparison with scalpel incisions. [9]

Related Research Articles

<span class="mw-page-title-main">Lingual frenectomy</span>

A lingual frenectomy is the removal of a band of tissue connecting the underside of the tongue with the floor of the mouth. A lingual frenectomy is performed to correct ankyloglossia (tongue-tie).

<span class="mw-page-title-main">Frenulum breve</span> Medical condition

Frenulum breve, or short frenulum, is a condition in which the frenulum of the penis, which is an elastic band of tissue under the glans penis that connects to the foreskin and helps contract it over the glans, is too short and thus restricts the movement of the foreskin. The frenulum should normally be sufficiently long and supple to allow for the full retraction of the foreskin so that it lies smoothly back on the shaft of the erect penis.

<span class="mw-page-title-main">Ludwig's angina</span> Medical condition

Ludwig's angina is a type of severe cellulitis involving the floor of the mouth and is often caused by bacterial sources. Early in the infection, the floor of the mouth raises due to swelling, leading to difficulty swallowing saliva. As a result, patients may present with drooling and difficulty speaking. As the condition worsens, the airway may be compromised and hardening of the spaces on both sides of the tongue may develop. Overall, this condition has a rapid onset over a few hours.

<span class="mw-page-title-main">Ankyloglossia</span> Congenital disorder of tongue mobility

Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that may decrease the mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Ankyloglossia varies in degree of severity from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth.

<span class="mw-page-title-main">Frenulum of tongue</span> Small fold of mucous membrane

The frenulum of tongue or tongue web is a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue.

<span class="mw-page-title-main">Frenulum of lower lip</span>

The inferior labial frenulum, or frenulum labii inferioris. is the frenulum connecting the lower gums with the lower lip.

Epulis fissuratum is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture. More simply, epulis fissuratum is where excess folds of firm tissue form inside the mouth, as a result of rubbing on the edge of dentures that do not fit well. It is a harmless condition and does not represent oral cancer. Treatment is by simple surgical removal of the lesion, and also by adjustment of the denture or provision of a new denture.

A dental laser is a type of laser designed specifically for use in oral surgery or dentistry.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

<span class="mw-page-title-main">Labial frenectomy</span>

A labial frenectomy is a form of frenectomy performed on the lip.

A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

Inferior alveolar nerve block is a nerve block technique which induces anesthesia (numbness) in the areas of the mouth and face innervated by one of the inferior alveolar nerves which are paired on the left and right side. These areas are the skin and mucous membranes of the lower lip, the skin of the chin, the lower teeth and the labial gingiva of the anterior teeth, all unilaterally to the midline of the side on which the block is administered. However, depending on technique, the long buccal nerve may not be anesthetized by an IANB and therefore an area of buccal gingiva adjacent to the lower posterior teeth will retain normal sensation unless that nerve is anesthetized separately, via a (long) buccal nerve block. The inferior alveolar nerve is a branch of the mandibular nerve, the third division of the trigeminal nerve. This procedure attempts to anaesthetise the inferior alveolar nerve prior to it entering the mandibular foramen on the medial surface of the mandibular ramus.

Orofacial Myofunctional Disorders (OMD) are muscle disorders of the face, mouth, lips, or jaw due to chronic mouth breathing.

A lisp is a speech impairment in which a person misarticulates sibilants. These misarticulations often result in unclear speech.

TransOral Robotic Surgery (TORS) is a modern surgical technique used to treat tumors of the mouth and throat via direct access through the mouth. TransOral Robotic Sleep Apnea (TORSA) surgery utilizes the same approach to open the upper airway of patients with obstructive sleep apnea. In TORS and TORSA procedures, the surgeon uses a surgical robot to view and access structures in the oral cavity (mouth) and pharynx (back of the throat) without any incisions through the neck, chin or lip (these incisions are necessary in traditional, non-robotic approaches). Current TORS techniques include radical tonsillectomy, resection of palate and base of skull tumors, hemiglossectomy and resection of tumors above and involving the larynx. The TORSA technique is used for uvulopalatopharyngoplasty, hemiglossectomy, and other airway procedures.

Laser gingivectomy is a dental procedure that recontours or scalpels the gingival tissue to improve long term dental health or aesthetics. Compared to conventional scalpel surgery, soft-tissue dental lasers, such as Laser diode, Nd:YAG laser, Er:YAG laser, Er,Cr:YSGG laser, and CO2 lasers, can perform this procedure, offering a precise, stable, bloodless, often less painful, and accelerated healing experience. However, the Laser diode gained more popularity due to its versatility, less interaction with hard tissue, ease of use, and the less expensive set up.

Tongue training is a technique used to encourage proper tongue motion. Tongue training is used to treat individuals suffering from Ankyloglossia and other tongue dysfunctions. It is important for individuals suffering from orofacial myological disorders. Tongue training is a method used to teach the correct accent of any language.

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. The objectives of this surgery include accessibility of instruments to root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal diseases control, oral hygiene maintenance, maintain proper embrasure space, address gingiva-alveolar mucosa problems, and esthetic improvement. The surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

References

  1. Archer, WH (1952). Oral and Maxillofacial Surgery. W.B. Saunders Co. p. 407.
  2. Baxter, Richard; Musso, Megan; Hughes, Lauren; Lahey, Lisa; Fabbie, Paula; Lovvorn, Marty; Emanuel, Michelle; Agarwal, Rajeev (2018). Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More. United States: Alabama Tongue-Tie Center. pp. 19–34. ISBN   978-1-7325082-0-0.
  3. Ghaheri, Bobak A.; Cole, Melissa; Fausel, Sarah C.; Chuop, Maria; Mace, Jess C. (2017). "Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study". The Laryngoscope. 127 (5): 1217–1223. doi:10.1002/lary.26306. ISSN   1531-4995. PMC   5516187 . PMID   27641715.
  4. Fraser, Lyndsay; Benzie, Stuart; Montgomery, Jenny (2 October 2020). "Posterior tongue tie: the internet phenomenon driving a lucrative private industry". BMJ Opinion. The BMJ . Retrieved 12 June 2020.
  5. Merkel-Walsh, Robyn; Gatto, Kristie (2021). "The Team Approach in Treating Oral Sensory-Motor Dysfunction in Newborns, Infants and Babies with a Diagnosis of Tethered Oral Tissue". Journal of the American Laser Study Club. 4 (1): 28–45. ISSN   2576-7852.
  6. Riek, C; Vitruk, P (Spring 2018). "Incision and Coagulation/Hemostasis Depth Control During a CO2 Laser Lingual Frenectomy". Dental Sleep Practice. MedMark: 32–38.
  7. Chiniforush, Nasim; Ghadimi, Sara; Yarahmadi, Nazli; Kamali, Abbas (2013). "Treatment of Ankyloglossia with Carbon Dioxide (CO2) Laser in a Pediatric Patient". Journal of Lasers in Medical Sciences. 4 (1): 53–55. ISSN   2008-9783. PMC   4281972 . PMID   25606307.
  8. Fiorotti, Renata C.; Bellini, Bruno S.; Cassitas, Nilceu P.; Baldin, Diva H. Z.; Nicola, Ester M. D. (2000). "Use of CO 2 laser in lingual and labial frenectomy". In Featherstone, John D. B; Rechmann, Peter; Fried, Daniel (eds.). Use of CO2 laser in lingual and labial frenectomy. Lasers in Dentistry VI. Vol. 3910. pp. 117–123. doi:10.1117/12.380818. S2CID   71245438.
  9. Zeinoun, T.; Nammour, S.; Dourov, N.; Aftimos, G.; Luomanen, M. (2001). "Myofibroblasts in healing laser excision wounds". Lasers in Surgery and Medicine. 28 (1): 74–79. doi:10.1002/1096-9101(2001)28:1<74::aid-lsm1019>3.3.co;2-2. ISSN   0196-8092. PMID   11430446.

Further reading